Does tobacco marketing promote co-use of tobacco and alcohol and undermine quit attempts?

Objective: Tobacco marketing links tobacco with alcohol use, but effects on behavior is unknown. We examined the relationship between tobacco marketing susceptibility and co-use of tobacco and alcohol, and co-use and smoking cessation behavior among young adult bar patrons aged 21-26.

Methods: Cross-sectional survey at bars using randomized time location sampling in San Diego, CA, Tulsa and Oklahoma City, OK (N=3,497). Smoking when drinking alcohol at bars, tobacco marketing susceptibility, past-year quit attempts, and intention to smoke in next year were measured. Multivariate logistic regression models analyzed the association between tobacco advertising susceptibility, tobacco and alcohol co-use, cessation attempts, and intention to smoke, controlling for demographic variables.

Results: About 50% of participants were current smokers; 96% of current smokers reported smoking when drinking alcohol at bars; 36% of tobacco and alcohol co-users reported they owned or would use tobacco branded items. Susceptibility to tobacco marketing predicted regular co-use of tobacco and alcohol (OR=1.72, 95% CI=[1.37, 2.14]). Of co-users, 41% reported past-year quit attempts, but 85% reported intention to continue smoking in the next year. The frequency of co-use was positively associated with past-year quit attempts (OR=1.13, 95% CI=[1.09, 1.16]), and with intention to continue smoking (OR=1.25, 95% CI=[1.21, 1.30]), controlling for covariates.

Discussions: Tobacco marketing susceptibility is associated with tobacco and alcohol co-use. Frequent co-users are more likely to intend to continue smoking, but are also more likely to report past-year quit attempts, suggesting a willingness to try. Tobacco cessation interventions should prioritize young adult co-users of tobacco and alcohol.